Thumb Surgery Alternative?
Is there a real thumb surgery alternative? Can thumb arthritis be cured? Let’s dive into the pros and cons of thumb surgery and how we have helped many people avoid thumb surgery through a new precise injection technique.
What is the CMC Joint of the Thumb?
The CMC (Carpal-Metacarpal) joint of the thumb is between the wrist bones (carpals) and the bone that makes up the base of the thumb (metacarpal). This is the main pivot and support point when you use your thumb to grab something, so it gets the most wear and tear. This is also called the basal joint or the basal joint of the thumb. The wrist bone that makes up the bottom of the joint is called the trapezium.
What Does Thumb Arthritis Feel Like?
Thumb arthritis most often occurs at the CMC joint in patients in their forties or fifties and is much more common in women (1). About 1/3 of all people will get some level of arthritis at the base of the thumb, although not all of those patients will have disabling symptoms. The pain is typically felt where the thumb meets the wrist and things like opening a jar, grabbing for a doorknob, or shaking someone’s hand can be painful. The problem is called CMC arthritis, basal joint arthritis, or more commonly these days, “texting thumb”.
Why Does the Thumb Hurt?
The biggest issue that causes pain and fries the joint over time is instability. Meaning when the CMC joint ligaments that precisely align the joint get loose, the joint experiences too much wear and tear which breaks down the cartilage and causes bone spurs. This causes the thumb to swell, which causes pain. If you have loose ligaments elsewhere (also called Ehlers-Danlos syndrome in it’s worst form), then CMC arthritis is more common (2).
How Do I Get Rid of Arthritis in My Thumb?
There is no way to completely get rid of arthritis in your thumb. However, as I’ll discuss a bit later in this piece, you can get the instability fixed through a specialized injection protocol that in my experience works as well as surgery without much of the risk. However, before I tell you about a thumb surgery alternative, let’s dig into what surgery looks like.
What is the Best Surgery for Thumb Arthritis?
There are a few common options here:
- Take out a wrist bone and place a tendon in that spot-called Trapezectomy and Tendon Interposition (7)
- Take out only the trapezium wrist bone (6)
- Replace the joint (8)
- Take out a wrist bone and place an artificial spacer in that spot
The most common procedure is LRTI (ligament reconstruction and tendon interposition), which is where the trapezius bone that makes up half of the CMC joint is removed and a tendon is inserted. While this surgery is a common treatment for CMC arthritis, there is no research that shows that it works better than a sham surgery, which is usually the gold standard for procedure testing (5). Interestingly, the procedure where just the bone is removed (trapezectomy) has far fewer complications (4-6X less) and about the same outcomes as LRTI (3). The complication rate for LRTI, in general, is about 19%, which is fairly high (5).
Joint replacement is another option. This is the amputation of the joint and the insertion of one of the many prosthetic joints on the market. However, don’t expect results like other joint replacements. For example, a recent review on the topic showed that for some the procedure worked, but for others, it was ineffective or resulted in more surgery (9).
An artificial spacer is a bad idea, as in many studies complication rates were very high (1/3 of patients or more) (4). As a result, one spacer called Artelon resulted in a class-action lawsuit against the device manufacturer. As a result, this procedure is no longer offered as much.
As you can see, the research on surgery for this condition would push anyone to consider a thumb surgery alternative.
Is There a Thumb Surgery Alternative?
What if I told you that for the last decade or so I have been helping patients avoid thumb surgery through a precise ultrasound-guided injection of their own platelets or stem cells? For our clinic, this all began when I was the first physician in the world to inject bone marrow stem cells into the CMC joint as a thumb surgery alternative. I published on the excellent results we observed helping these patients recover without an invasive procedure (10).
Since then we’ve refined the technique to work both by using the patient’s own concentrated platelets or stem cells. In this procedure, we carefully inject these substances into the loose ligaments and arthritic joint after numbing the area with a nerve block. This is a walk-in/walk-out procedure without bracing or the need to avoid using the hand. We’ve seen success rates of 80% or higher in patients who have been told they need one of the surgeries described above. To learn more, check out the video below:
If you want to see what these procedures look like, check this video below:
There are lots of doctors out there who claim to be able to treat all sorts of problems with stem cells. As the first physician in the world to do many of these procedures, this is a bit disturbing to see, as many are poorly trained. Be careful out there if a doctor says that he can perform this CMC procedure using amniotic or umbilical cord stem cells. To make sure you don’t get scammed, read my short little book below:
The upshot? Surgery for thumb arthritis is a big decision with many risks. However, the thumb surgery alternative we have developed can help many patients avoid thumb surgery!
(1) Haugen IK, Englund M, Aliabadi P, et al. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study [published correction appears in Ann Rheum Dis. 2018 Oct;77(10):1546]. Ann Rheum Dis. 2011;70(9):1581–1586. doi:10.1136/ard.2011.150078
(2) Jónsson H, Valtýsdóttir ST, Kjartansson O, Brekkan A. Hypermobility associated with osteoarthritis of the thumb base: a clinical and radiological subset of hand osteoarthritis. Ann Rheum Dis. 1996;55(8):540–543. doi:10.1136/ard.55.8.540
(3) Naram A, Lyons K, Rothkopf DM, et al. Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone. Hand (N Y). 2016;11(1):78–82. doi:10.1177/1558944715617215
(4) Clarke S, Hagberg W, Kaufmann RA, Grand A, Wollstein R. Complications with the use of Artelon in thumb CMC joint arthritis. Hand (N Y). 2011;6(3):282–286. doi:10.1007/s11552-011-9332-x
(5) Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. 2015;2015(2):CD004631. Published 2015 Feb 23. doi:10.1002/14651858.CD004631.pub4
(6) Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio‐metacarpal joint. Journal of Bone & Joint Surgery 1949;31(4):357‐9. https://www.ncbi.nlm.nih.gov/pubmed/15397137
(7) Burton RI, Pellegini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. Journal of Hand Surgery1986;11A(3):324‐32. https://www.ncbi.nlm.nih.gov/pubmed/3711604
(8) Swanson AB. Disabling arthritis at the base of the thumb: treatment by resection of the trapezium and flexible (silicone) implant arthroplasty. Journal of Bone and Joint Surgery 1972;54A(3):456‐71. https://www.ncbi.nlm.nih.gov/pubmed/5055148
(9) Huang K, Hollevoet N, Giddins G. Thumb carpometacarpal joint total arthroplasty: a systematic review. J Hand Surg Eur Vol. 2015 May;40(4):338-50. doi: 10.1177/1753193414563243.
(10) Centeno CJ, Freeman MD. Wien Med Wochenschr. 2014 Mar;164(5-6):83-7. Percutaneous injection of autologous, culture-expanded mesenchymal stem cells into carpometacarpal hand joints: a case series with an untreated comparison group. doi: 10.1007/s10354-013-0222-4.